Healthcare Provider Details

I. General information

NPI: 1104768944
Provider Name (Legal Business Name): CYNTHIA GRACE EARL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G1069 N BALLENGER HWY
FLINT MI
48504-4431
US

IV. Provider business mailing address

203 PARK AVE
HOLLY MI
48442-1425
US

V. Phone/Fax

Practice location:
  • Phone: 810-235-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: